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American Society for Action on Pain

UI - 000135

AU - Finley RS

TI - Pain management with spinally administered opioids. [Review]

AB - The use of spinally administered opioids to manage pain is discussed. Central action on opioid

receptors of the substantia gelatinosa allows opioids to be administered spinally for pain originating

anywhere inferior to the cranial nerves. Spinal opioids are most commonly administered for intractable

midline sacral and perineal pain. The best candidates for spinal opioids are patients in whom appropriate

"conventional" therapy no longer provides adequate relief, patients who experience severe adverse effects

from conventional therapy, and patients for whom alternative anesthetic procedures are inappropriate or

have failed. A reasonably safe initial dose is morphine sulfate 1 mg intrathecally. The availability of

preservative-free, concentrated morphine sulfate enables larger doses to be safely and comfortably

administered. Increased dosage requirements may result from tolerance, progression of disease, increased

systemic absorption, or slippage of the catheter tip. As with systemically administered opioids, care must be

exercised when discontinuing spinal opioid therapy. Adjuvant drugs used with spinal opioids include

systemically administered analgesics, antidepressants, corticosteroids, and spinal local anesthetics. The

administration of spinal opioids with systemic opioids or other CNS depressants may result in excessive

sedation, respiratory depression, nausea, vomiting, constipation, pruritus, and other adverse effects. Spinally

administered opioids can be used to manage severe chronic pain effectively, safely, and comfortably.

[References: 29]

SO - American Journal of Hospital Pharmacy 1990;47:S14-S1